Oral Health Reports from the 50 States & District of Columbia

June 7th, 2012

June 2010

The Failure of the Fluoridation Experiment – Part 2.
By Ellen Connett, Fluoride Action Network

Part 1: Introduction
Part 2: Oral Health Reports from the 50 States in the US, plus the District of Columbia
Part 3: Tooth Loss by State
Part 4: “The 14 Worst-Teeth Cities” by Sarah Carrillo, published by TotalBeauty.com
Part 5: “The 12 Best-Teeth Cities” by Sarah Carrillo, published by TotalBeauty.com

Note: All BRFSS reports at http://wdh.state.wy.us/brfss/brfssdata.aspx

Fact Sheet. Oral Health Coalition of Alabama. Undated.
• Two out of every five Alabama schoolchildren are estimated to have untreated tooth decay.• Almost 70 percent of low-income children in Alabama did not visit a dentist last year.• Alabama has about 30 percent fewer dentists statewide than the nation (38 dentists in Alabama versus 54 per 100,000 population nationally) and our dentists are not distributed evenly.• One-third of all Alabamians over age 65 have no teeth, the 9th highest percentage in the country.• Alabama is the 4 lowest in the nation in terms of per person spending for dental care.• No mention of the number of children in Alabama with dental fluorosis.

Alaska

59.5%

13. Oral Health. Healthy Alaskans 2010 – Volume I. Undated.… There is relatively little information available on Alaska’s incidence of caries.A 1989 study of 3-5 year old children enrolled in Alaska’s Head Start Program found 55 percent of children screened had untreated dental decay, found evidence of baby-bottle tooth decay (early childhood caries) in 25 percent of Native children and 4 percent of non-Native children, and 20 percent of all teeth in these children had evidence of past or present caries.… Low-income individuals also have a higher incidence of dental decay.Alaska low-income individuals often have diets high in processed foods and refined sugars. They frequently have less access to dental care either because of distance or cost…. Preliminary data from the 1999 Indian Health Service Oral Health Survey indicates the Alaska Native dental clinic user population has more than twice as many decayed or filled teeth as non-Natives. The current situation in rural Alaskan villages is similar to the situation faced in the United States prior to World War II. Historically, a number of studies documented the low decay rates in Native populations in Alaska.4,5,6,7 The traditional diet of Natives in most of Alaska was rich in protein and fats and very low in sugars and other fermentable carbohydrates. Studies conducted since the 1920s have documented the relationship between dental decay and increased ingestion of refined sugar and other carbohydrates in the Native population.• No mention of the number of children in Alaska with dental fluorosis.Whistler BJ. 2007. Alaska Oral Health Plan: 2008-2012. Women’s, Children’s and Family Health, Division of Public Health, Alaska Department of Health and Social Services.

Alaska’s caries experience rates (evidence of past or present dental decay) are higher than the national baseline of 52%, with 65 percent of Alaskan third grade children with caries experience at the time of the assessments. Higher dental decay rates were seen in third graders from racial/ethnic minority groups. High dental decay rates in Alaska Native children have been noted in previous Indian Health Service dental assessments, however the 2004 third-grade dental assessments in Alaska found similar caries experience rates in third-grade Asian and Native Hawaiian/Pacific Islander racial/ethnic groups (See Figure 1). About the same percentage of Alaska third-graders had untreated decay at the time of the dental assessment, 28%, as the national baseline for 6-8 year olds (29%). Similar patterns were seen in terms of untreated dental decay in Alaskan third-graders with higher rates in third-graders from racial/ethnic minorities (See Figure 2). Untreated decay was found in 43.5% of Alaska Native children; rates were higher for Asian third-graders (49.5%) and Native Hawaiian/Pacific Islander third-graders (52.4%).

• No mention of the number of children in Alaska with dental fluorosis.

Arizona

56.1%

The Oral Health of Arizona’s Children. Current Status,Trends and Disparities. November 2005. Division of Public Health Services, Public Health Prevention Services, Office of Oral Health.1. Almost 39% of Arizona’s third grade children have untreated tooth decay.2. Almost 9% of Arizona’s children in kindergarten to third grade have urgent dental care needs.3. While 31% of Arizona’s eight year-old children have at least one sealant, 81% need initial or additional sealants.4. Only 57% of Arizona’s children in kindergarten through third grade visited the dentist in the last year.5. Oral health status varies among children with different types of dental insurance, and among children with and without dental insurance.

6. Arizona has substantial disparities in oral health. Low-income children, Hispanic children, and children of racial minority have more dental treatment needs.

… As the graph shows, there is an inverse relationship between income and untreated tooth decay (in other words, as income increases, tooth decay decreases). Over 50% of children from low-income households have untreated decay and 15% have urgent dental needs. More low-income children have never been to a dentist and fewer have dental sealants. Low-income children are also less likely to have dental insurance; 33% of the lowest income children have no dental insurance compared to 13% of the highest income children.Refer to Table 5.

… Of 22 states with oral health data, Arizona ranks third highest in the proportion of third grade children with untreated tooth decay. Arkansas has the highest prevalence of untreated decay (42%), followed by Oklahoma (40%), Arizona (39%) and Nevada (39%).Vermont has the lowest prevalence of untreated decay (16%). More Information is available through the National Oral Health Surveillance System (NOHSS), www.cdc.gov/nohss.

• No statitstics were given on dental fluorosis even though “More than 13,000 children received dental screenings.” and “each tooth surface was scored for decay, restorations, sealants, fluorosis, trauma, premature loss, and eruption status…”

Arkansas

64.4%

Too Few Visits to the Dentist? The Impact on Children’s Health. A Special Report from Arkansas Advocates for Children & Families. February 2002…. Oral health in Arkansas is in a dire state. Arkansas was recently graded “D,” along with nine other states. Forty other states were graded “C-” or above…. Research proves children living in low-income families fare woefully when seeking and accessing oral health. More than half — over 400,000 Arkansas children — live at or below 200 percent of poverty. All children living at or below this poverty level qualify for the state’s Medicaid insurance program, but most dentists don’t accept this type of insurance…. The overall oral health system for children in Arkansas is in a state of emergency. The problems are more pronounced in rural areas. Although more than 46 percent of Arkansans live in rural areas, 54 percent of dentists are concentrated in seven metropolitan cities, where only 19 percent of Arkansans live…• No mention of the number of children in Arkansas with dental fluorosis.

California

27.1%

Snapshot. Haves and Have-Nots: A look at children’s use of dental care in California. California HealthCare Foundation. 2008.• This report “examines the most recent data available from the 2005 California Health Interview Survey and presents a more detailed look at racial/ethnic differences and other factors that contribute to disparities in dental care for California’s children…”• Significant racial/ethnic differences in dental visit rates exist, even among Latino and Asian subgroups.• California’s elementary school children have high rates of cavities, higher among Latino (72 percent) than White (48 percent) children.• In 2005, 24 percent of California’s 6 million children had never visited a dentist.• Children with any of the following characteristics are more likely to fall through the dental safety net: aged five and under; without dental insurance; from low income, Latino, or African American families; or whose parents lack English fluency.

• No mention of the number of children in California with dental fluorosis.

• A survey of over 21,000 California children in kindergarten or third grade, in nearly 200 randomly-selected schools spread across the State during the 2004-2005 school year.

• Almost three out of four low-income children in elementary school have had a cavity, as compared to about half who are not low income.

• The oral health of California’s children is substantially worse than national objectives. Of 25 states surveyed, only Arkansas ranked below California in kids’ dental health.

• The problem is worse for the poor, for Hispanics and other ethnic minorities, and for the uninsured. Barriers to dental care, including parents’ financial difficulties or a lack of dental insurance, can have a profound impact on children’s dental heath. About one-third of low-income children have untreated decay compared to about one-fifth of higher income children.

• Poor children and children of color are much more likely to have tooth decay and suffer the consequences of untreated disease.

• We found that Latino children have the highest risk for dental health problems. Seventy-two percent of Latino children surveyed had experienced decay, 30% needed treatment, and fully 26% had rampant decay (caries on seven or more teeth) – nearly twice the rates of non-Hispanic white children surveyed.• No mention of the number of children in California with dental fluorosis.

• Projections of Californians receiving fluoridated water (12% in 1990; 17% in 1995; 35% in 2000; 45% in 2005; projected 70% in 2010)

• Data on fluoridation by state water systems in 2008

Colorado

73.6%

The Colorado Health Report Card. 2008. The Colorado Health FoundationColorado ranks in the bottom tier of states (38 out of 50) for children reported to have received all preventive dental care needed in the past 12 months. Disparities exist for children living at various income levels.Only half of children living in households below the poverty level received preventive dental care in Colorado in 2003, while over 80 percent of children living in higher income households received such care.• No mention of the number of children in Colorado with dental fluorosis.Addressing the crisis of oral health access for Colorado’s children.Colorado Commission Children’s Dental Health. A Report to The Honorable Bill Owens Governor, State of Colorado. December 2000.• low-income and at-risk children have severe and urgent oral health care needs.

• many children lack access to oral health care services.• there is a dental workforce shortage in Colorado.

• No mention of the number of children in Colorado with dental fluorosis.

Connecticut

88.9%

Oral Health in Connecticut.2007. Connecticut Department of Public Health… Ethnic minorities are disproportionately affected by oral disease in Connecticut…… The prevalence of dental caries in children and adults in Connecticut is not well known….In 1997, a small open mouth survey of second graders found 57% had caries experience and 40% of those had active, untreated cavities.11 These data, however, were not representative of second grade children statewide and so could not be generalized to this population. (page 4)… Having some of the wealthiest as well as some of the poorest cities in the nation has earned the state the title of the Two Connecticuts.

… The Two Connecticuts demographic profile referred to in the previous section is evident in the oral health status of the state’s residents. Those who are affluent, well educated, and non-minority are more likely to have fewer obstacles to good oral health. The most vulnerable populations, including the elderly, poor, uninsured, racial and ethnic minorities, disabled, and those challenged by transportation barriers, face significant oral health problemsin, including tooth decay and periodontal (gum) disease. dentition with brown and black decayed tooth structure. (pp 3-4)

… Cleft lip/palate ranks fourth among all birth defects.

• No mention of the number of children in Connecticut with dental fluorosis.

Delaware

73.6%

Delaware Oral Health Assessment of Third Grade Children. May 2002. Delaware Health and Social Services, Division of Public Health.• The sample consisted of 23 schools with a total third grade enrollment of 2,739. Of the 23 schools selected, 19 agreed to participate in the survey for a school response rate of 83 percent. These 19 schools had a total third grade enrollment of 2,395. Parental consent was received for a total of 1,032 children, which resulted in a response rate of 43.1 percent among participating children from the 19 schools.• Children who are eligible for the free/reduced price meal program are significantly more likely to have untreated decay and need dental care• Children who are eligible for the free/reduced price meal program are significantly more likely to have untreated decay (40% vs. 23%) and need dental care (40% vs. 23%)• African-American and Hispanic children were significantly more likely to need dental treatment (40% and 44% respectively) compared to white children (24%)

• Hispanic children were significantly less likely to have private dental insurance (33%) compared to white children (66%)

• There was no significant difference in oral health status between children in Kent, New Castle, and Sussex counties

• The primary reasons for not being able to get dental care were “could not afford it” and “no insurance”

• No mention of the number of children in Delaware with dental fluorosis.

District of Columbia (Washington DC)

100 %

Issue Brief: Oral Health is Critical to the School Readiness of Children in Washington, DC. 2007. Produced by Altarum Institute and funded by Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.Low-income Children in Washington, DC are at High Risk for Poor Oral Health and Consequently Inadequate School Readiness. Close to one-half of the infants and toddlers in the District of Columbia live in low-income families, and almost one-quarter live in extreme poverty (below 50 percent of the federal poverty level of $8,300 annually for a family of three). A study conducted at the Children’s National Medical Center found that District children with a history of dental caries, most of which were from low-income families, were significantly more likely to exhibit failure to thrive, or an inability to gain weight or grow as expected.Behavioral Risk Factor Surveillance System (BRFSS) 2006 Annual Report. Government of the District of Columbia, Department of Health, Center for Policy, Planning and Epidemiology.The likelihood of having one’s permanent teeth removed increased by age. Over 90% of adults aged 18-24 had all of their permanent teeth, compared to only 22% of adultsaged 65 years and older.• Caucasians reported the highest percentage of all other races to have all of their permanent teeth (79%)— compared to 67% of Hispanics, 64% of adults of “other” races, and only 45% of African Americans.

• As education and household income increased, so did the percentage of District adults having all of their permanent teeth. By education, one-third (33%) of adults with less than a high school degree had all of their permanent teeth, compared to almost three-fourths (71%) of adults with a college degree. By income, less than half (41%) of adults who had a household income below $15,000 had all of their permanent teeth, compared to 73% of adults with a household income of $75,000 or more. There was a wide variety in responses by ward. Adults in Ward 3 were the highest percentage to have all of their permanent teeth (76%), whereas less than half of adults residing in Wards 4, 5, 7, and 8 had all of their permanent teeth.

… The percentage of adults who had their teeth cleaned within the past year increased dramatically by education and household income… There is a more pronounced difference by income; 38% of adults with a household income below $15,000 had their teeth cleaned within the past year, compared to 81% of adults with a household income of $75,000 or more.

Ward 7 and 8 adults were the lowest percentage of residents to have been to the dentist or hygienist within the past year for a dental cleaning compared to adults of other wards—58% and 54%, respectively. This is compared to 75% or more of adults residing in Wards 1, 2, and 3 (75%, 79%, and 87%, respectively)

… Low-income children [in Palm Beach County] are 5 times less likely to receive dental treatment than their wealthier counterparts.

… Of the approximately 1.3 million residents residing in PBC [Palm Beach County] 26% live below 200% of the poverty level and 10% live below 100% of the poverty level.

• No mention of the number of children in Florida with dental fluorosis.

Georgia

95.8%

Status of Oral Health in Georgia. Summary of Oral Health Data Collected in Georgia.2007. Georgia Department of Human Resources.Excerpts:• Poor oral health is a significant public health problem among Georgia residents.• Overall, Georgia adults meet the Healthy People 2010 Objectives for dental visits and tooth loss; however, lower income groups do not meet these objectives• More than half (56%) of all surveyed third grade students in Georgia have carries experience and more than a quarter (27%) have untreated decay.• Georgia (56%) has a higher percentage of children with dental caries experience than the national average (51%).

• The percentage of adults aged 35-44 years who have lost no teeth due to decay or disease increases with increasing income level.

• The percent of adults aged 65-74 years who have lost all natural teeth due to decay or disease decreases with increasing income level.

• Adults with an annual household income greater than $50,000 are most likely to have had no teeth extracted (75%) at ages 35-44 and are least likely to have lost all of their natural teeth at ages 65-74 (9%).

• Adults aged 65-74 years with an annual household income of less than $15,000 are most likely to have lost all of their natural teeth (34%).

• No mention of the number of children in Georgia with dental fluorosis.

Hawaii

8.4%

Oral Health 2001. A strategic plan for oral health in Hawai‘i.The link between health and wealth is well established in public health research and is in evidence in the oral health findings in Hawai‘i. For key indicators such as visits to dentists and loss of teeth, there is a clear correlation of better oral health for those with financial resources. For example,• 61% of persons with income over $50,000 retained all their teeth while this was true of only 40% of persons with income below $15,000. The low-income population in our state remains significantly vulnerable to poor oral health conditions.• No mention of the number of children in Hawaii with dental fluorosis.–

Issue Brief: Expanding Access to Oral Health Care in Idaho. 2008.Nationally, as much as 80 percent of tooth decay occurs in just 25 percent of children.Data from Idaho demonstrate similar trends,• the highest rates of caries experience and need for restorative treatment are concentrated among low-income and racial and ethnic minority children …• The percentage of Idaho’s total population lacking access to dental care is twice the national average (19 percent versus 9 percent).

• More than 90 percent of Idaho is designated as a dental health professions shortage area.

• Nearly 20 percent of dentists are approaching retirement age.

• Dentists are retiring at a faster rate than students are graduating from dental schools.

• Idaho ranks second in the Nation for percentage of personal health care expenses spent on dental care.

• No mention of the number of children in Idaho with dental fluorosis.

… Illinois has among the lowest rates in the nation for government funded dental care. As a result we face an oral health care crisis… Illinois currently has just one clinic per 8,400 children who rely on government insurance.• newspaper article, no mention of fluorosis

Indiana

95.1%

Oral Health Needs in Indiana: Developing an Effective and Diverse Workforce. May 2009. Center for Health Policy.… Although there is a lack of a formal and continuous surveillance system on oral health in Indiana, some state-level information is available from the Behavioral Risk Factor Surveillance System (BRFSS), a random telephone survey of state residents age 18 and older in households with a telephone. Results from the 2006 BRFSS also indicated that 47 percent of Hoosiers ages 18 and older have had permanent teeth extracted—a percentage that was significantly higher than the national median of 44 percent (see Figure 2).

Groups with the highest prevalence of tooth extractions included blacks; individuals with an annual household income of less than $35,000; and individuals with lower educational attainment. Prevalence of extractions was highly associated with age – as age increased so did the percentage of Hoosiers who reported having had any permanent teeth extracted.

… The elderly, minorities, and low income citizens often face the unfortunate need to have some or all of their teeth extracted.

… Hoosiers that are on Medicaid are another vulnerable group, since coverage of dental services in Indiana is limited to $600 per recipient per year.

… Indiana’s ratio of dentist-to-population is low, and it has become progressively worse over the past 17 years. As the population of the state has increased, the number of dentists has decreased.

• No mention of the number of children in Indiana with dental fluorosis.

Iowa

92.4%

2009 Third Grade Open Mouth Survey Report. Oral Health Bureau, Iowa Department of Public Health. Survey report prepared by Mary Kay Brinkman and Tracy Rodgers. Statistics prepared by Xia Chen…. The participation rate was 65 percent (1,206 of 1,850 potential third grade students). The survey indicates that 49.2 percent of the children have at least one sealant on a permanent first molar, 21.9 percent have untreated decay and 46.7 percent have at least one filled tooth. (See Table 2.)

The majority of children, 88.3 percent, were White/Caucasian; 5.4 percent were Hispanic/Latino and 4.1 percent were Black/African American. Black/African American children are much less likely to have dental sealants (33.3%) compared to White/Caucasian (49.8%) and Hispanic/Latino (47.5%) children. In addition, minority children are less likely to have a dentist of record and much less likely to have private dental insurance than White/Caucasian children.

Participation in the free/reduced lunch program is used to determine the number of children from lower-income families, in order to compare oral health status of those children to those from families with higher socio-economic status. Of the children participating in the free/reduced lunch program, 26.6 percent have untreated decay compared to 19.2 percent of the children not in the lunch program.

… when looking at race/ethnicity, access to preventive sealants for Black/African American children is much lower than for other children. Race/ethnicity also appears to be a factor in accessing regular dental care. Although most parents indicate their child has a dentist (92.5%), there is a large disparity between the White/Caucasian children and the Black/African American and Hispanic/Latino children.

… Survey results show more children with untreated tooth decay in 2009 than in the 2006 survey (21.9% compared to 13.2%).

… This year’s survey included a higher percent of children participating in the free/reduced lunch program (37.8%) than the state average for 2008-2009 (34.1%). There was also a higher percent of Medicaid-enrolled children (19.8%) when compared to the 2006 survey (16.1%). These may both be factors in the higher overall decay rate this year.

• No mention of the number of children in Iowa with dental fluorosis.

Kansas

65.1%

Research Brief. The Oral health of Kansas children.By Barbara J. LaClair. Kansas Health Initiative. KHI/09-04 • February 2009…. Kansas children were similar to others throughout the nation in their oral health status and access to dental care. About 72 percent of Kansas children had teeth that were in excellent or very good condition, slightly better than their peers across the nation. But not all Kansas children fared as well. Hispanic children, children from households with low incomes and children without dental insurance were significantly less likely to have had teeth in very good or excellent condition. Children who were uninsured or covered by public health insurance sources were significantly less likely to have had teeth in excellent or very good condition than those with private insurance (Figure 1)…

• No mention of the number of children in Kansas with dental fluorosis.

Oral health problems in Appalachia are considered severe, with Kentuckians having some of the worst oral health outcome indicators in the nation across all age groups. Kentucky ranks second in the number of completely edentulous older adults, third in adults with any permanent teeth extracted, and sixth in the prevalence of individuals not visiting a dentist or dental clinic within the past year for any reason (1). Though Kentucky has a high rate of water fluoridation (2), teeth cleanings and dental sealants comparable to the nation’s, it still has a higher rate of caries experience and untreated caries among children. Parents in rural Kentucky report that their children are less likely to have teeth in excellent condition and to have dental insurance than their urban counterparts.
• No mention of the number of children in Kentucky with dental fluorosis.

Nationally, Kentucky had the nation’s highest percentage of edentate [toothless] persons, those who have lost all their natural teeth due to tooth decay or gum disease, among working-age adults (age 18 to 64) in 2004; the second highest percentage among older adults (age 65 and older); and, as shown in Table 1, the second highest percentage among adults aged 18 and older. Kentucky ranks 8th for adults who have lost at least one permanent tooth due to tooth decay or gum disease and 14th for adults who have lost 6 or more teeth….the findings of a 2001 state survey of children … found disturbingly high levels of cavities among two- to four-year-olds (47 percent), and visible, untreated tooth decay among 29 percent of third and sixth graders…. Kentucky’s relative poverty, particularly the disproportionate poverty of its older citizens, and its generally poor health status are likely strong contributors to the state’s poor oral health profile

• No mention of the number of children in Kentucky with dental fluorosis.

Louisiana

40.4%

Brushing Up on Children’s Oral Health in Louisiana . A Policy Brief. A project of Agenda for Children and the Oral Health Program, Office of Public Health, Department of Health and Hospitals. Undated.In Louisiana, children ‘s oral health is in a state of crisis. Only 37% of Medicaid -eligible children received dental services during the last year. It is not until age 7 that 90% of children visit a dentistMedicaid eligible children in Louisiana are 3-5 times more likely to have untreated dental decay than non eligible children.Barriers to accessing oral health services are experienced by many Louisiana families, particularly those of low-income, minority populations.A study by the Louisiana Oral Health Program, in which school nurses screened third grade children throughout the state, revealed that 38.1% of children had untreated caries.In some areas of Louisiana, the waiting list to see a dentist that accepts Medicaid is 4-6 months. Waiting lists for dental clinics in New Orleans vary from two months to one year.

The 1999 Behavioral Risk Factors Surveillance System (BRFSS) survey shows that the length of time since the last dental visit was greater than 2 years in 39.4% of Louisiana’s residents surveyed. There was a racial disparity found with the percentage of 50% for black residents compared to 34% for white residents.

There is an inequitable distribution of dentists through out the state, especially in rural areas. Sixteen Louisiana parishes are designated by the federal government to be Health Professional Shortage Areas. (HPSA)
• No mention of the number of children in Louisiana with dental fluorosis.

Maine

79.6%

Maine Oral Health Improvement Plan. Published by the Maine Dental Access Coalition. November 2007.Disparities in Maine, notable in terms of access to oral health care services and oral health status, are related largely to socioeconomic factors and are compounded by our predominantly rural state’s geography and population distribution as well as by the distribution of dental professionals.• No mention of the number of children in Maine with dental fluorosis.Oral Health in Maine: Facts & Figures. August 2005. Judith A. Feinstein MSPH, Director, Maine Oral Health Program — (Power Point)– Nearly 25% of new moms said they needed a dental visit during pregnancy; but of these, 35% did not go.–The women who did not obtain needed care were more likely to be 20-24 years old, enrolled in WIC, or have annual incomes of less than $16,000.2004 Maine Child Health Survey, Preliminary Data
— Of the children screened, 15% of kindergarten and 17% of the 3rd graders had untreated dental decay.
— Of the kindergarten children screened, 11% hadn’t had a dental visit.
— Of the 3rd graders screened, 57% had at least one dental sealant, but 50% of them needed at least one more.
— 15% of the kindergarten children and 41% of the 3rd graders who were screened have decay experience (fillings and/or decay).
— In 1999, 38% of lower income children had sealants; in 2004, 53% of the lower income children screened have them – a level similar to higher income children.
• No mention of the number of children in Maine with dental fluorosis.

Maryland

93.8%

2007. Survey of the oral health status of Maryland school children 2005-2006. Authors: Richard J. Manski RJ, Chen H, Chenette RR, Coller S. University of Maryland Dental School.This “survey” is a dental evaluation of the State’s public school children in kindergarten and 3rd grade. It consists of a simple oral screening and a brief oral health questionnaire. The Survey is a follow-up to the 1995-1996 and the 2000-2001 surveys and is designed to assess the current status of oral health among Maryland school children. Survey highlights include:• Approximately, 31% of school children in Kindergarten and Grade 3 had at least one tooth with dental caries.• School children in Kindergarten and Grade 3 residing on the Eastern Shore were more likely to have at least one tooth with dental caries than similad.r children residing in Southern Maryland or Western Marylan• Non-Hispanic Black school children in Kindergarten and Grade 3 were more likely to have at least one tooth with dental caries than Non-Hispanic White children.

• Non-Hispanic Black school children in Kindergarten and Grade 3 were less likely to have at least one tooth with a dental sealant than Non-Hispanic White children.

• Other characteristics of school children with at least one tooth with dental decay:

– Living in households eligible for free and reduced meals;

– With a parent/caregiver who did not graduate from college;

– Covered by Medicaid dental coverage

– No private dental insurance coverage;

– Prior dental caries experience in the past 12 months

– No treatment for dental caries in the past 12 months.

• Other characteristics of school children without any dental sealants:

– Living in households eligible for free and reduced meals;

– Covered by Medicaid dental coverage;

– No dental visit in the past 12 months;

– No treatment for dental caries in the past 12 months.

• No mention of the number of children in Maryland with dental fluorosis.

Massachusetts

59.1%

The Oral Health of Massachusetts’ Children. Executive Summary. Report by the Catalyst Institute. January 2008.Children from low-income families and children from certain racial/ethnic groups not only have a much higher prevalence of oral disease but are also less likely to have had their dental caries treated. Among kindergarten children, the proportion of Hispanic children with untreated decay (23.5%) and the proportion of children from low-income families with untreated decay (25.7%) were at least double that of comparable groups. (Page 4)Significant racial, ethnic and socioeconomic disparities exist within all oral health indicators, at each grade level, and among the state’s 14 counties. (page 5)
• No mention of the number of children in Massachusetts with dental fluorosis.

Michigan

90.9%

Michigan Oral Health Plan. September 2006. Michigan Department of Community Health…. People of low socioeconomic status in Michigan bear similar oral health burdens as their national counterparts. Those in poverty are less likely to have visited a dentist in the past year or have had their teeth cleaned. Those with high school educations or less are also less likely to visit a dentist either for treatment or preventive services. For both those at low-income and low-education levels, tooth loss appears at much higher rates. The 2002 Michigan BRFSS demonstrated that 47.6% of individuals with household incomes below $20,000 had not visited a dentist in the previous year. In contrast, only 15.9% of individuals with household incomes between $50,000 and $74,999 had not visited the dentist within the previous year…. Dentists are maldistributed across Michigan resulting in a deficiency of providers in primarily rural areas. Twelve Michigan counties have less than five dentists, nine Michigan counties lack a dentist who accepts Medicaid, and one county has no dentist available…. Non-Hispanic blacks are more likely to be missing at least one tooth at age 35-44 and to be edentulous (without teeth) at age 65-74.
• No mention of the number of children in Michigan with dental fluorosis.

Minnesota

98.7%

Minnesota Oral Health Data Book. Children and Youth. October 2006. Minnesota Department of Health. Community and Family Health Division.Many Minnesota children and youth now enjoy better oral health than did their parents. However, certain segments of the population, such as, those who are poor, have special health care needs, or are members of racial or ethnic minority groups, still have severe tooth decay, much of which remains untreated…. In Minnesota more than 98% of municipal water systems contain optimal fluoride levels (0.9 to 1.5 parts per million) to prevent dental caries in children…• Children from low income families (<200% of federal poverty level) receive less preventive dental care than children from higher income families in both MN and the US.• 80% of MN children from higher income families (>200% of poverty level) have teeth in excellent or very good condition, compared with only 51% of children in very low income families (<100% poverty level). U.S. Data are similar.• MN figures show even greater disparity between preventive care for White children (81%) and those of Black (59%) or Hispanic heritage (53%) when compared with U.S. Data (77%, 66%, 61%, respectively.)• racial/ethnic minority children in MN have the lowest percentage of children’s teeth in excellent or very good condition (47-52%) compared with White children (79%).

• In summary, there are few differences between U.S. And MN oral health trends. However, a greater percentage of MN children received preventive dental care across all age groups, likewise more MN children were reported to have excellent or very good teeth at all ages, compared with other U.S. Children. These data also reflect basic health disparities between White and non-White children in MN.
• No mention of the number of children in Minnesota with dental fluorosis.

Mississippi

50.9%

The Oral Health of Mississippi’s Third Grade Children 2004-2005 School Year. October 2005. Mississippi Department of Health.Excerpts of Key Findings
• Dental decay is a significant health problem for Mississippi’s third grade children.
— 69 percent have cavities and/or fillings (decay experience)
–39 percent have untreated dental decay (cavities)• African American children have poorer oral health and less access to preventive dental sealants.
— Compared to white children, African American children have a significantly higher prevalence of decay experience and untreated decay; but a significantly lower prevalence of protective dental sealants. In addition, almost twice as many African American children are in need of urgent care because of pain or infection (12% vs. 7%).• Children from low-income schools have poorer oral health and less access to preventive dental sealants.
— Compared to children from higher income schools (<50% eligible for free or reduced price meals), children in low-income schools (> 75% eligible for free or reduced price meals) have a significantly higher prevalence of decay experience and untreated decay; plus a significantly lower prevalence of dental sealants.• In general, children in Mississippi, compared to children from other states, have poorer oral health.
— Mississippi ranks as the 4th worst in the prevalence of children with decay experience, untreated decay, and dental sealants. Only Arkansas ranks lower than Mississippi in all three areas of oral health status.
• No mention of the number of children in Mississippi with dental fluorosis.

Missouri

79.7%

Show Me Your Smile. The Oral Health of Missouri’s Children. Executive Summary. December 2005. Missouri Department of Health and Senior Services, Office of Primary Care and Rural Health, Oral Health Program….More than 1 in 4 third graders and more than 1 in 5 special health care needs children
in Missouri has untreated tooth decay. Of the sixth graders screened, 22% had
untreated tooth decay…. Compared to white children, African-American children had a significantly higher prevalence of decay experience and untreated decay, but a significantly lower prevalence of protective dental sealants. In addition, more than twice as many African-American children were in need of urgent care because of pain or infection (8% vs. 3%).• The percentage of African-American third graders with sealants (25%) is less
that that of white children (29%)…. Compared to children from higher income schools (<25% eligible for free or
reduced price meals), children in low-income schools (> 75% eligible for free or
reduced price meals) had a significantly higher prevalence of decay experience and untreated decay, plus a lower prevalence of dental sealants.
• No mention of the number of children in Missouri with dental fluorosis.Oral Health Program. 2009 Annual Report. Missouri Department of Health and Senior Services. Office of Primary Care and Rural Health. Oral Health Program.
• See page 1. Exhibit 2: Fluoridated Water Systems/Districts in Missouri
• No mention of the number of children in Missouri with dental fluorosis.

Montana

31.3%

Montana Oral Health Plan. Montana Department of Public Health & Human Services. 2006.Montana faces critical access problems in oral health care due to an inadequate supply and maldistribution of dental professionals, very high uninsured population and poverty levels, limited access to dental services to low income and special populations, which is compounded by the lack of a professional dental school in the state. Rural and frontier communities face special challenges that require community ingenuity and partnership efforts at both the state and grassroots levels…. 80 % of 2-5 year old American Indian/Alaska Native children have untreated dental decay…. 25 % of third grade students screened during 2002-2004 were reported to have dental decay…. 19.6% of Montana residents surveyed had lost 6 or more teeth due to decay or gum disease…. 19.6% of surveyed Montana adults 65 years and over reported having had all their natural teeth… 25% of Montana counties were without an enrolled Medicaid dental provider in 2005.
• No mention of the number of children in Montana with dental fluorosis.

Nebraska

69.8%

Open Mouth Survey of Third Graders. Nebraska 2005. Nebraska Health and Human Services System.A total of 2,057 third-grade school children participated in the Open Mouth Surve. … Key Findings:• Dental caries is a significant public health problem for Nebraska school children, with approximately 60% of children experiencing dental disease by the third grade and 17% having untreated dental decay or cavities.• Children from lower-income schools tend to have poorer oral health; approximately 30% of children from low-income schools having untreated dental caries.• Minority children experience poorer oral health, with approximately 28% of minority children having untreated dental decay and 20% having rampant caries.
• No mention of the number of children in Nebraska with dental fluorosis.

Nevada

72.0%

Nevada Head Start Oral Health Screening Survey. August 2007. Health Nevada State Health Division, Bureau of Family Health Services.• Dental decay is a significant public health problem for Nevada’s Head Start children.
— 54.0 percent of Head Start children had cavities and/or fillings (caries experience).
— 37.5 percent of Head Start children had untreated dental decay (cavities).
— 25.3 percent of Head Start children had Early Childhood Caries (ECC is the presence of 1 or more decayed, missing due to caries, or filled tooth surfaces in any primary tooth in a child 71 months of age or younger, also known as baby bottle tooth decay.)
— 37.4 percent of Head Start children were in need of either restorative or urgent dental care.• Minority children have poorer oral health.
— 44.4% of White Non-Hispanic children had caries experience, a significantly lower proportion than that of Hispanic children (56.8%) and Non-Hispanic Minority children (54.0%).
— 30.2% of White Non-Hispanic children had untreated decay, a significantly lower proportion than that of Hispanic children (38.9%) and Non-Hispanic Minority children (38.7%).
— 16.3% of White Non-Hispanic children had ECC, a significantly lower proportion than that of minority children. The proportion of Hispanic children (28.6%) with ECC was significantly higher than that of Non-Hispanic Minority children (24.0%).
• No mention of the number of children in Nevada with dental fluorosis.** Also see The Burden of Oral Disease in Nevada – 2006. August 2007. Department of Health and Human Services, Oral Health Program.
• No mention of the number of children in Nevada with dental fluorosis.

New Hampshire

42.6%

Oral health in New Hampshire. Data brief. January 2008. New Hampshire Department of Health and Human Services…. The following is a summary of data gathered by the 2006 New Hampshire Behavioral Risk Factor Surveillance Survey (NH BRFSS) related to oral health. The BRFSS is a telephone survey of non-institutionalized adult New Hampshire residents…. Data from the 2006 BRFSS showed that 18.6% of New Hampshire residents that were 65 years old or older were edentulous [the loss of all teeth]. Significant association was observed between tooth loss and both education (Figure 3) and income (Figure 4)… Data from the 2006 BRFSS demonstrate clear disparities in oral health by socioeconomic status. Individuals living in households with lower income or those with less education are significantly more likely to report dental disease and less likely reporta recent visit to the dentist or dental clinic.– In 2006, only 28.5% of adults 65 years old and older had some type of dental insurance.
• No mention of the number of children in New Hampshire with dental fluorosis.See also, New Hampshire Oral Health Data 2006. New Hampshire Department of Health and Human Services. Oral Health Program.
• No mention of the number of children in New Hampshire with dental fluorosis.

New Jersey

22.6%

Pediatric Oral Health Action Plan for New Jersey’s Children Aged 0-6. Funded by New Jersey Head Start-State Collaboration Grant and The Association of State and Territorial Dental Directors. April 2009.• Access to dental services for New Jersey’s preschool-aged children is fraught with challenges. This is particularly true for New Jersey’s most vulnerable children, those enrolled in Early Head Start/Head Start (EHS/HS) and insured by Medicaid. Although nearly all Head Start children are eligible for Medicaid and/or NJ FamilyCare dental coverage, most do not receive adequate dental care. In addition, many eligible children are not enrolled in Medicaid. New Jersey has a shortage of dentists interested in serving the Medicaid population. Most general dentists do not focus on treating children aged 0 to 6. Additionally, there are not adequate numbers of pediatric dentists (specialists) available to treat children with extensive caries. Head Start Performance Standards (initial dental examand follow-up care) are not being met.• New Jersey lacks adequate statewide data on childhood oral health disease prevalence and pediatric oral health service utilization. The New Jersey lacks adequate statewide data on childhood oral health and oral utilization.
• No mention of the number of children in New Jersey with dental fluorosis.Kaiser State Health Facts. 2008.Percentage of Adults 65+ Who Have Had All of Their Natural Teeth Extracted, 2008 = 17.1% (US average = 18.5%)Percentage of Adults Who Visited the Dentist or Dental Clinic within the Past Year, 2008 = 75.9% (US average = 71.3%)Percentage of Adults (ages 18 and above) Who Report Having Had Their Teeth Cleaned Within the Past Year, 2008 = 74.1% (US average = 68.4%)
• No mention of the number of children in New Jersey with dental fluorosis.